European Journal of Public Health, Vol. 16, No.

5, 536–541
Ó The Author 2006. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.
doi:10.1093/eurpub/ckl025 Advance Access published on March 8, 2006

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Adolescent
health
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Frequent computer-related activities increase
the risk of neck–shoulder and low back pain
in adolescents
Paula T. Hakala1,2,3, Arja H. Rimpela¨1, Lea A. Saarni1, Jouko J. Salminen4
Background: Neck–shoulder pain (NSP) and low back pain (LBP) increased among adolescents in the 1990s
and the beginning of 2000. A potential risk factor for this increase is the use of information and communication technology. We studied how the use of computers, the Internet, and mobile phones, playing
digital games and viewing television are related to NSP and LBP in adolescents. Methods: Mailed survey
with nationally representative samples of 14-, 16-, and 18-year-old Finns in 2003 (n ¼ 6003, response rate
68%). The outcome variables were weekly NSP and LBP. Results: NSP was perceived by 26% and LBP by
12%. When compared with non-users, the risk of NSP was 1.3 (adjusted odds ratios) when using computers >2–3 h/day, and 1.8 when using 4–5 h/day; 2.5 when using computers $42 h/week, and 1.7 when
using the Internet $42 h/week. Compared with non-users, the risk of LBP was 2.0 when using computers
>5 h/day, 1.7 when using $42 h/week, 1.8 when using the Internet $42 h/week, and 2.0 when playing
digital games >5 h/day. Times spent on digital gaming, viewing television, and using mobile phones
were not associated with NSP, nor were use of mobile phones and viewing television with LBP after
adjusting for confounding factors. Conclusions: Frequent computer-related activities are an independent
risk factor for NSP and LBP. Daily use of computers exceeding 2–3 h seems to be a threshold for NSP and
exceeding 5 h for LBP. Computer-related activities may explain the increase of NSP and LBP in the 1990s
and the beginning of 2000.
Keywords: adolescence, computer, digital games, Internet, low back pain, mobile phone, neck–
shoulder pain

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ow back pain (LBP) and neck pain (NP) are significant

L health problems not only in adults but also in the young.

In studies exploring populations of 300 children or more,1
the lifetime prevalence of LBP has ranged from 30% to 51%.
NP has emerged as one of the most common pain symptoms
and the most persistent musculoskeletal pain symptom.2,3 In
adolescence, 15–30% suffer from weekly NP and 1–15% from
weekly LBP.4–6 Co-morbidity of the symptoms has been
reported.5
Based on Finnish large-scale population surveys Hakala et al.6
showed that neck–shoulder pain (NSP) and LBP increased
among adolescents in the 1990s and the beginning of 2000.
Comparing findings from two surveys within several countries,
the WHO cross-national survey showed that in 1993–1994
every fifth 11- to 15-year-old reported weekly backache7 and
by 1997–1998 the figure had risen to every third.8 To assess
causes behind this development, we need to explore emergence
of new risk factors as well as changes in the prevalence of those
previously known.
Female gender, age, history of spinal trauma, parental
history of LBP, disc degeneration, increased height and
sitting height, high level of physical activity, television viewing,

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1 Tampere School of Public Health, FIN-33014 University of
Tampere, Finland
2 Tampere University Hospital, PO Box 2000, FIN-33421 Tampere,
Finland
3 City of Helsinki, Health Centre, PO Box 6100, FIN-00099 Helsinki, Finland
4 Department of Physical and Rehabilitation Medicine, University
Hospital of Turku, PO Box 52, FIN-20520 Turku, Finland
Correspondence: Paula T. Hakala, Tampere School of Public
Health, FIN-33014 University of Tampere, Finland, tel: þ358 50 363
8669; fax: þ358 3 215 6057, e-mail: paula.t.hakala@uta.fi

smoking, depression, and stress increase the risk of non-specific
LBP.1 Of these risk factors television viewing among 10- to 14year-olds has increased in the 1990s,9 yet some studies have
reported no association between LBP and time spent on viewing
television.10 Although little studied, NP in children has been
associated with early timing of puberty, high intensity of physical exercise, smoking,5 female gender, stress, and depressive
symptoms.5,11 It is unlikely that changes in the known risk
factors could explain the increase in NP and LBP.
A major change in the 1990s and the beginning of 2000 was
the explosion in the use of information and communication
technology (ICT). In the beginning of the 1980s computer
use by adolescents was negligible but the use increased steeply:
the average daily use among 10- to 14-year-olds was 11 min in
1987–1988 and 47 min in 1999–2000.9 At present, most adolescents use computers regularly for surfing in the Internet,
playing games, writing or keeping contacts via e-mail. Further,
two other forms of ICT, playing digital games on play consoles
and use of mobile phones, have tremendously increased. As an
activity, playing console games and using computer resemble
each other; sitting work in static posture with repetitive upper
extremity movements. Mobile phones are used not only for
phoning but also for playing games and sending text messages,
the latter activities have similarities to computer use.
Studies on adult work life support a hypothesis that
computer-related activities can cause NP and LBP in the
young.12 Neck symptoms have been associated with low or
high screen position, shoulder symptoms with high screen position and shoulder elevation in computer mouse users,13 and the
risk of NP with poor placement of keyboard.14 Use of keyboard
for $4 h during a working day has been associated with
shoulder, wrist, or hand pain but not with NP.15 Further,
work exceeding 15 h/week at visual display units presented as
a risk factor for NSP.16 An obvious reduction in musculoskeletal

... . .. . . .. .... .. .. . . ... ... . . ..... . .... . . . . .. ... ... . . . .. . . . . ... . .. .. .. ... .. .... .. .... ... .... $42 h .. . .. .. .. . neck.. It was hypothesized that computer-related activities increase NSP and LBP in adolescents. .... . ..... . .. ......... . . ... ... . ..... . .. . . ...... ....... . ... .... . .. . ........ ... . . . . ..... ..... .. ... 50%)........ ... . . .. . .... .... . .. ... . .... . . .. ... .. . . . . ... .. . ... . . ... . ........ ... .. .. . . .. . . ..... .. . . ... .. . . .... . .. ....... .. .. . and 18-year-olds in February with two re-inquiries to nonrespondents... . text messages . ..... . . . .. ..... .. . .. . . ...... .. .. .. ..... . .. .. ... . ... .. . ..23 The association between mobile phones and back or neck pain has not been studied earlier.. . .. . .. . . . . .. ... . . .. . ... . . ..... .. . . . . .... ....... .. . ..... .. . .. . . . . . . ... ... .. . .. . . . . . .. .. .. .... . . . .. .. .. .. ... . . . .. .... . ..... . . .. . . . ..19.... ....4 1 1 2 100 100 100 . .. .. .... . . . ... .. .... .. .. ... .. .... ... . .... . About once a week 8 12 14 14 22 25 16 .. ... .... ...... . .. . . ... . ... ... .. . . . and response rate was 68% (14-year-old girls: n ¼ 1245.. . . About once a month 28 30 29 30 32 32 30 ... . ...... .. .... . . ... .. .... . ... .. .. .. ...... ... . ... ... . ... .. .. ... ..... . . .. ..... . . .... .....6 0.. .. . . Specific computer activities such as using joystick or playing games were significantly predictive of physical discomfort.. . .... . ...... ... .. ... ... .. . .. .. ... . . ... ... . . . .. . .. ...... . . . . . ..... ... . . ... . ..... .. ... . ... . .. .. . .. .... ... . ..... . .. . . . . . .. ... . ... . . . .. . . . . A significant association was discovered between the number of hours spent on computer and overall musculoskeletal pain in a sample of 152 adolescents.. .. ... .. .. .. .. . ... . . . . . . .. ... .. .... . .. .. . ... ... . ..... . .. ...... . . .. . . . .. .. .. . .. . ... . . . . .. ...... ....... . . ..22 time spent with computer was associated with neck/shoulder pain among 11-.. . ... . ..... .. ... .. . . . a nation-wide monitoring system of Finnish adolescents. ... .. About once a month 15 19 20 24 36 34 25 .. ... . . .. .. . .... . ... . . . .. . .9 7 5 7 4–5 h 1 2 3 1 1 1 2 >5 h 1 2 3 0. ... .. . . .... .... . . ... ... .. .... .... . .. ....... .. . ..... ... ....... . . ... . . ..... . 79%. ... . . . ......2 0.. .. ... . . ... ... ... .. . Our study investigates how the use of computers.. .... ... .. .. .. .... ... . . . . . .. ... . .. . .. . . .. .. . .. .. . .... . . . ... .. ... . ..19 Furthermore. . . . . . . . . .... . ... . . . . .. ... .. ...... .. . .... Not at all or not daily 70 58 56 68 66 70 65 #1 h 23 28 27 24 25 23 25 2–3 h 5 10 11 6. ..... ... . ... . . ..... .. . ... .. . 18-year-old boys: n ¼ 570... . ... .... .. . .. .... ... . ....... .. . . ... ... . .. . ... . . . . ... .. . . . . .... ... . . . . . . . ..... .. .... .. ... .... .. ..... .. . . .3 2 .. .. .. . . ... .. . ...... . . ..... ... . 16-year-old boys: n ¼ 1003.. .. 100 100 100 100 100 100 100 . . . . . .. . ... .. ... .. .... .... .. . .. Some cross-sectional studies have indicated that the time spent on viewing television and video is positively related to back pain.. ... ... . . . . . . . . . .. . ... . .... . ... .. .. .. ..... ... .. ... . . . . .... .... . . .. ........ .. . . ........ Daily playing digital games . .. . .... . . . .. . . .. ..... .. . ..... . . .. ... . ... .... ... . .. ... ... . ....... .... . . . . .. .... . ..... . ... . . .. .. .... . . . . .... . .. ....20 Gunzburg et al... . . ... . . ... .. . . . ...... . .. .... ... .. .. . ... ........... ... . ... . ......... . ... ... . . . . . . . ... . . . .... . Almost daily 3 5 6 9 16 20 10 . ... . 16-year-old girls: n ¼ 1296.. ... ... ... . ..... . .. ..... . .. ..... ....... . .. . . .... . . .. . . $42 h .. . ......20 and 60% of 10.. ... . . . . . . .. . ..... . .. . .. . ..... . . 78%. . ... ...... ... . .. Total 100 100 100 100 .... . .. .. .. .. . . . . .... .. ... .. . . .. ... . .... . . .. .. ... .. . . . . ... .. .. .... .. 74%.. . .. ... ....... ... .. ... .. . . ... . . . . ..... . .. . ... . . .. ... . . .... ... .. . .... ... ... ........ ... . . . . .. ... ... .. ... . ... . .. . . .. . ..... . . ........ ... ..... . . . . .. . .. ... . ... . .. ... . ... . .... . . ... . ....... .. ... .. .. . .. . ..... . . .... . . .. ... . .. . .... .. . .. . . .. .... ... ... . ..... .. .. . ..... .. . ... .. . .... .. ..... . ... ....... . . . ... . . ... . ......6 3 >5 h 3 5 3 0.... .. ..... . About once a week 5 8 11 5 8 13 8 ... .... ... .. . . . ... . . . ... .. . .... .. . . .. ....... 14-year-old boys: n ¼ 1092. ... . .... ... ... .... ..... .. ... .. .. .. . .. ... .... . ...... ... . Methods We used data from the Adolescent Health and Lifestyle Survey 2003... . . . . . . . . ...... . .. . . ... .. ..6 0... . ... 59%.... . ... .... .. . ...... . . . . .. ... .. . . . . .. . Total .. .. . . .. .... ..... .. .... . .. .... .. .. .. .. .. . . .... .... . . ... ... .. .. .. . .. ... ... . .. .... ... ... . .. . .. . . . .. . .... . . ... .... . .. . .. . ......... . ....... . ... .. . . .. . . ... . .. .. .... . .. ...... .. .. .. .. . ... ... .... ... ... . . . ... . Not at all or not daily 29 35 57 82 87 92 65 #1 h 29 26 20 13 9 6 17 2–3 h 32 27 17 4 3 1 13 4–5 h 7 7 3 0.. . ... .. .. .. ..... and upper back areas has been observed after instructed computer users’ sitting posture and workstations. . discomfort in the shoulder. .. ... .. .... . .. . .... . . . . . . .. . . . . . . . . . . ..... . .... . .... . . .. ..... .. .... . . . . ..... ... . ..... ... . . .. . .. .... ... .. . .. . ... . .... ... . . . . .. .. .. . ... . .... .. . .... .. ... . .. . ..... .to 18-year-olds... . . . .... . . .... .. ... . . . . . .... . . ... .. . . . . Weekly use of computer .. ... .17 Of the few studies investigating the association of computer-related activities with back or neck pain in adolescents. . . .. .... .. .... .. . .1.. .. . . . . ...... . .. ... ... . ... . .. ... . 49 . . . .. . .. . . . ... . .. .... .. .. . .. ....18 Computer use exceeding 15 h/week was a risk factor for LBP in a sample of 88 adolescents... .. . . ..... . . ..... ... ... .... ... and use of ICT by sex and age... ..... .......... ... .... . ... . video.. .... .... . . . . .. ....... . .. .. . ... . ........ .. .. .... .... ... . . .. .. ... . .. .. ... ... .. ..... .. . .... .. .. ... . ....... . .... .. ....... ... ..... ... .... . .... ... ..... ... . . . . .. .. .. . . . ..... . .. .... . .... .. ... .. ....... . . .... . . . ... Seldom/not at all 61 53 51 47 30 23 44 . .. ... .... .......... ... ... . ... ..... .. . .. .. . . ... .. . . . ... .. . . . .... . .. . . .. .. ...... .. .. ... . ... 212 students (age 5–18) experienced discomfort in the back (15%) attributable to computer use.. ...... . .. . . . . .. ... . . . . .. . .. .. . . . ... ... . .to 17-year-olds reported discomfort in the neck region during laptop computer use.. . ... Total 100 100 100 100 100 100 100 Daily viewing TV. ... . .. . . . .. ... .. .... . . . or DVD Not at all or not daily 14 13 19 13 15 13 14 #1 h 28 31 26 25 27 20 26 2–3 h 48 45 43 51 47 54 49 4–5 h 7 8 9 9 9 11 9 >5 h 3 3 3 2 2 2 2 ... .. ... .. .. .... . ...... . .. ....... . . ..... ... .. .. .... . . .. 16-... ... ...... . .. ... . . . . . . .... .. LBP . . . .. .... ... .... .. ... .... ... .. .. . . . . . .. . . .. . . and mobile phones. ... ... . ... ... .... ... .. . . . .. .. .......... ... . . . . ... ... . ... . . ... . ..... . .... ... .. . .. . ... ..... . . .. . . .. . . . Almost daily 1 4 5 2 5 5 4 .... . . . . . . .. . NSP . .. . . ... ....... . .. . Daily use of computer ..... .... ..... . . . ... . . . . . . .. . ....537 Computer-related activities increase the risk of NSP and LBP Table 1 Continued Table 1 Prevalence rate (%) of NSP and LBP. .. ... . .. . ... . ...... . ....... Not at all or not daily 44 38 32 30 21 20 31 #1 h 55 62 57 64 67 59 .. ... .. . .. .. .... ... ... . ..... .... . .. . .... . . ... . ..... . .... ... . .. .... . . . .. . .. . .. .. . . .. . .. ... . .. . . .. . .... . ... ... . .. . . .. ..... . . .. Not at all 5 4 6 10 10 13 8 1–13 h 67 62 66 83 83 80 74 14–41 h 26 30 23 7 6 6 16 2 4 5 0.. . . . . . . ... ... . .. . .... . . . ... . . .. . . .21 According to the results from a larger study (n ¼ 4404) documented by Alexander and Currie. .. ... . .. . .. . .. .. . . ... ... .... .... .... ....... ... . . . .. .... .. ... . . .. .. ... ..... . .. .. .. . . . ... . ... ... .... . .. . playing digital games and viewing television are related to NSP and LBP in a national survey of 14.. . .. 66%. . .... . .... .. .. ... . ... . . . . .. . .... ... . ... . .. ..... . . . . . .. .. ... ....... .. . . . .. Total 100 100 100 100 100 100 100 . . . ... . ... . .. . . . . ... . .. ......... . .. . ... . . . .... . . .. .. .. . . . .. . . ... . . .. .. .... . . . .. . .. . ..... . . .. ... .... . . .. . .. .. . . . . .. .... small samples. . . . .. ...... .... . Self-administered questionnaires were mailed to 14-. ... . .. .. . .... ..... . .. . .. .. .. .. .... .. .. ... . . ..... ... . . . . . . .. . .... .. ...... ....... .. . .. Weekly use of the Internet .. . ... . Total 100 100 100 100 .. .. . . ... .. .. ... ... .... . . . ... .. . . ......... . . ... . .. .... .... . .. ...... ... . ... ....... ... .. . .. ... ... . . . ... . .. ... .. . ... ... .. . .. .. .. . . ...... ... ........ .. . .... . .. . .. ... . ... .. .. . . .. . Not at all 14 11 11 14 13 14 13 1–13 h 75 72 74 80 82 82 77 14–41 h 10 14 12 5 4 3 8 1 3 3 1 1 1 2 100 100 100 100 100 100 100 . . . .... . . ....... . . ... ... ... . . .. . . .. .. .. .. .... . . . . . .. . ... .. . . . . .. .. .. .. .. . . .. . . ... . ... . . . ...... in 2003 Frequency Frequency Boys (age) Girls (age) 14 14 Boys (age) All 14 16 18 16 Alla Girls (age) a 18 16 18 14 16 18 2–3 h 5 5 5 9 11 10 8 4–5 h 1 1 1 2 2 1 1 >5 h 1 1 0 2 2 2 1 . . . . . . ... . .... .... ... . . ... .. .. . . . . .. ... .... . . . . .. .. . .. .. . ....... 6003 responded. ... .. . . .. .... . ... .. . ... most are cross-sectional with unrepresentative. ... .. . . ... . .... ... .. .. ... ... .. . .. ... . . . .. ... .. . . . . ... .. ... .. . ... .... ... . ... ....2 0.... . .... . ... ... ..... . .. . .. . .. Total Total 100 100 100 100 100 100 100 a: Age and sex adjusted . . .. . . . . ........ .. . ... .. .. .. . . . ..... .. . . . .. . . .... . .. . . . .. . . ..... . .. . .. . . . . .. ..... . . . . .... .. .. . .. . . . . . . ... . . . . .... ...... . ... ... .... .. .. 13-.. . . .. . .. . .. . .. Seldom/not at all 79 69 64 69 51 48 63 100 100 100 100 100 100 100 ... .. . . .. .... . . . . ...... . . . . ... . .. .... Sample size was 8810.. . . . . .. . ...... . . .. . . . . ... . ... .... . . .... .. . .. . ... . ..... . .. .. . . . . . . .. ..... .. . .. . .. ..... ... .. .. ... . . . .. .. ...... . . . . .. . .... . .. ... . . Total . . . .. .. .. ...... .. .. . . ... . . .. . . .....1 1 1 1 100 100 100 .. . . . ............ .. .. ... . . . ..... the Internet. ... .10 discovered significantly more LBP in 9-year-old children who played video games >2 h/day. . . . ... . and 15-year-olds. .. . . .. ... . .. .. .. . .... .... playing games... ... . .. . . .... .... ...... .... .. . .. . . .... .. . 18-year-old girls: n ¼ 797.. . ... .... . .. ..... .. ..... . .. . .. .... . . Daily use of mobile phones for phoning. ... .. . . . ... ... ....... . . . ..... .. . .... . . .. .... ... .. . . . . . .. ... . . .. . ... . . .. . . . ..

and the variables on ICT use were predictor variables. $42 h/week in the Internet use. 0. Removal limit for variables was 0. video.9 h daily). Results were 0. respondents were asked: ‘Have you had low back pain during the past half a year?’ Alternatives provided were the same. 0. weekly NSP and LBP were outcome variables. and (iii) >13 (late). (iii) about once a week. which. (v) one has an upper secondary. better than average. Several confounding factors were controlled for in the analysis. and (vi) both have a tertiary education. playing digital games was no longer related to NSP. and it increased by age. but the dose–response relationship disappeared in daily computer use. and >5 h/day in playing digital games (models 1–3. text messages. timing of puberty. Alternatives were (i) not at all or not daily. Because NSP and LBP.56 for NSP. (ii) physical activity with low efficiency. model 1). feeling nervous/tension. The answers were divided into following four groups: (i) no physical efficiency. (iii) one has a tertiary (13–18 school years). headache. Two open questions were used: ‘How many hours on average do you use computer in a week?’ and ‘How many hours on average do you use the Internet in a week?’ The answers were categorized into four groups as follows: (i) not at all. but the latter disappeared in model 3.47 for mobile phones. Several exposure variables were used in order to increase the internal validity. (iii) physical activity with high efficiency. (v) not at school.65 for weekly use of the Internet. In the logistic regression analysis. and (iv) using computer for e-mails. videos. and (vii) 14 years. and efficiency of physical activity were included into the models (models 2 and 3). feeling dizzy) was categorized by counting the number of symptoms perceived at least weekly: no symptoms/ one symptom/two to three symptoms/four or more symptoms. Classification was derived from the official education statistics in Finland. Data were analysed by using the SPSS for Windows. In terms of NSP. In the analysis the target variable was dichotomized by joining categories (iii) and (iv) into ‘at least weekly’ and categories (i) and (ii) into contrast category. but not in viewing TV (table 2. 0.to 18-year-olds only). when parents’ education level. feeling tired/weak. These values represent a fair to good agreement beyond chance between the two questionnaires. (iii) daily 2–3 h.538 European Journal of Public Health The sample was drawn from the Population Register Center by selecting all Finns born at certain adjacent dates in July. (ii) weekly 1–13 h (corresponding <2 h daily). (iii) weekly 14–41 h (corresponding 2–5. the Internet. Risk of LBP was significantly higher when exposure time was $42 h/week and >5 h/day in computer use. In model 3. In terms of LBP. and LBP by 12% of 14. It was assumed that the later the person answers (original questionnaire/first re-inquiry/second re-inquiry) the more he/she resembles a non-respondent. the respondent was categorized according to the other parent’s education into groups (i). Seven groups were formed as follows: (i) high school. we wanted to see whether the relationships of NSP and LBP with ICT use were independent of other stress symptoms.to 18-year-olds (table 1). A subsample of 14. version 11. and 0. (ii) playing digital games (computers. and surfing. Parents’ level of education was divided into six groups as follows: (i) both parents have a primary/lower secondary education (up to 9–10 school years). (iv) other school.56 for LBP. adjusted for age and sex (model 1). average/worse.47 for viewing television.to 16-year-olds (n ¼ 800) was taken from the original subject series by systematic sampling. respondents were asked: ‘Have you had neck or shoulder pain during the past half a year?’ with alternatives (i) seldom or not at all. An identical questionnaire was sent to those who answered the survey (n ¼ 566) 4 weeks after receipt of their original questionnaire. stress symptoms variable was added. These variables were considered as potential confounders and treated as covariates. and (iv) efficiency unknown. (ii) high school. An index of eight stress symptoms (stomach ache. adolescents’ school success. Computer use of $42 h weekly. Statistical analysis. Timing of puberty was classified according to girl’s age at menarche into three categories as follows: (i) <12 (early). table 3). (ii) one has an upper secondary (up to 12 school years). Girls spent more time on using mobile phones. is an inconsistent result. and ICT variable. TV. . 0.24 Adolescents’ school success was measured by two questions according to respondent’s age: what kind of school respondent was attending to (relevant to 16.45 for weekly use of computers. After examining the effect of each ICT variable. Exposure time to ICT was measured by asking how many hours respondents spent daily on (i) viewing TV. playing games. or DVD. and efficiency of physical activity were adjusted for. difficulties in falling asleep/waking up at night. the other a primary/lower secondary education. Prevalence of NSP and LBP was higher among girls than among boys. console games). The data were divided into three categories according to the return date of the questionnaire.1. (ii) about once a month. 0. and what kind of grades respondent received last when compared to class average. and whether they got out of breath and sweated when exercising. (ii) at age 13 (average). or >2–3 h daily. because they were significant independent variables in the models with age. If the education of one parent was unknown. the Internet. better than average. the Internet. Efficiency of physical activity was measured by three questions: how often respondents participated in sports. (iii) other school. (iv) daily 4–5 h. parents’ level of education. or by age and sex. can be a dimension of general ill-health (stress). (iv) both have an upper secondary education. and also in viewing television (>5 h/day) in models 1 and 2. (ii) daily #1 h. randomizing the first. and (iv) almost daily. Times of viewing TV. Statistically significant results were obtained in mobile phone use in one category (2–3 h/day). In model 2. school success. A dose– response relationship was observed in the weekly and daily use of computers.54 for playing digital games. sex. (iii) using mobile phones for phoning. the risk increased with the increasing exposure time in the computer and the Internet use. and (iii) >13 (late). and the Internet use of $14 h weekly presented a threshold for weekly NSP. better than average. Risk of NSP increased parallel to increase in the use of computers. and gaming than girls. trembling of hands. irritability/temper tantrums. the other a tertiary education. writing. like the other measured stress symptoms. Use of mobile phones was no longer significantly associated with NSP. how often in other physical activity in their free time. Repeatability studies. and (v) daily >5 h. (ii) 12–13 years (average). average/worse. Results NSP was perceived once a week or more frequently by 26%. timing of puberty.0. the other a primary/lower secondary education. (vi) 14 years. Variables were included or excluded from each model based on the likelihood ratio test at 95% confidence level (95% CI). Of these 447 (79%) returned the questionnaire. 0. or (vi). and according to boy’s age at first ejaculation into (i) <13 (early). Adding stress symptoms (model 3).45 for daily use of computers. playing digital games and mobile phones. or DVD were equal in boys and girls (table 1). Boys spent more time on using computers. however. Odds ratios increased with the increasing time of using computers and the Internet. average/worse. Test–retest reliability of weekly symptoms and six ICT variables were tested with kappa coefficient. There were no systematic or statistically significant differences in categories of symptoms or ICT variables in the entire population. (iv). Analysis of non-respondents. and (iv) weekly $42 h (corresponding $5 h daily).

. . . .. ..9 2. .. . . ... ... . ... .. ..... .. . ..... .... . .. .6–1........ . . .... . . . .. .. .. .. . ..... .. .. . . .... . .0 1. ..1 0. . . ..... .. . .... .. ......... ..9 0. . .4–1... . . .7 1.. . ... .. .. . . . . .. . . ..... ..9 1.5 1. . Daily playing digital games Daily playing digital games . . . . ... .. . ... . . ...... . . . ... ..... . ...... . . .. . . .. ... . ...... . .. ... . .. . . ....1 2–3 h 1. . . . . .. .. .... . .. ...... .... . . .. . ..1–4... . . . ... ... . . ... ....... . . .. . ..7 1. . . . . .. .. . . . ... Separate models for each ICT variable Exposure to ICT 95% CI Weekly use of computer Not at all 1. . . ... ... .... . .....4 . ....0 2. ....... .. ... . . . . .. .. .. ...... ..6–1.... . . .1 2–3 h 1.... .... . . .. . . . .... . .. .. .. . . . . ....... .. Not at all or not daily 1.. . ... . . ... Odds ratios are given in boldface when they indicate a statistically significant difference from the odds of the reference category at 95% CI a: Model 1. . .... ..5–2..... . . . . . ..... .. ... . .. . .. .. .. ... .. .. . ... .. .... ... ... . .... .8–1. .. . .. .1 1.. . ..2 . . .. ... .8 1. .. . . ............ . . .. .. . ... ... ..... ... . ........ . .. ...... . . . ......0 1... . .3 1.... .....4 0.. ... .4 0.... ... .. . . . . playing games.0 1.. .... .. . .. . ..0–3... . .. . . ..0 #1 h 1.. ..9 0. . ....9 0... . .... . . . . .0–4... . . ...3 1.8 1.. . . . .4 1. . .... . . . .... or DVD .5 4–5 h 1. ... ..8 1. .. .. . .. . . ....1 . .. .... . .... ... . ...7 1.0 . . ....... ......9–1. . .. . . .. . .. ... ...2 1. ...... ..7–2. . Odds ratios are given in boldface when they indicate a statistically significant difference from the odds of the reference category at 95% CI . ..... .... . . .... .... .. . . sex.... . .. . .. . ..... .. .5 $42 h 1... .... . . .9 0. .. . . ...... . . . . . .. ... . .. ...0–3..... .. .... .. ..... . ... .. . . .. .. ... . .7–1.. Daily viewing TV. ... . .. ..0 1. .. .. ... .. .... . . .. ... ... .. ... .. . ...... . ... sex.0–3.9 0.... . . . .8–1. . .. .5 1... adjusted for age. .6–2.. . . . . ..0 1. . ... ... . .. 2–3 h 1. ... .0 1.. ...... .. ... .... .. . .. . .2 2–3 h daily 1...1 1. . .. .. ... . ... . . .. . . ... .... . ..... . .... .. .. .. .... .. . .. . .. ... ..... . . . . . . . ... . . .. .. .. . ..... ..9 1.7 0.... ... .2 0...... .7–1. .. ..... .. ... . . . ... .. . . ..... .... .. efficiency of physical activity c: Model 3. . . .... ....... . .... .... . ....7–1.... . . . . . .... .. . . . .. . . ..... . ..... . ... . . . ... . . . . . . . . . .. . . . .. .. . . .1 1..... . . .. .. .. . .. .. . . .. .... .7 1. . . .0 1. . ... . .... . . .. .. . . . .. . .. . . . . .. ..9 0. .. .2 0.... .... ..3–3... ... ..... . . ..... . . . . ... ... . . . .. ... ... . . .. .. .. adjusted for age...0 #1 h 1. ... .... sex. ... .. . . .. . ...... ... ..5–1.. .. .. .. school success. ..1 . . .... ..... ... . .7 0.. .. ...7–1.. . ... .3 1. . . . . ..0 0.2 0... . . .3 Daily viewing TV.. .... ... .. .... . ... ... . .... ... ...4 2... .. .. .. . . ... . . . . . .. .. . ...... .... . . . .. . . . . adjusted for age.... ..1 1. ....... .8 0. . . .. ...2 0... ... . . . . . .... ... ... . .0 1........ . .. .. . .3 1. . .. .. .. ... ... . .... . .. ... ... . .. . .. .8–1.. . ... . . . .... . .. .. .. . . . ...2 0. .... . ..6 1. . .. . ... .. . ..7–1..... .1 0......0 0.... .. . .. .. ... . . ... .6–1........ .. . ..... Daily use of computer Daily use of computer . ... . . . ... ..... .. . .. .8–1. . .8–2. .5–3. . .. ... ... . . . . . ... .. . ... . ...8 0. ..0 0.. . .. .9 0. . ... .... .... . .. . .. ... .....6 1. . ...... . ... . ... . . . . . .... Daily use of mobile phones for phoning.. . . .. . . .. . . . . . ... . ... .. . ... .. 2–3 h 1.9–3. . ... .. . ..... ........ . .. ... .. .. . . . . ... . .... ..... .. . .. ..5–4..... .. ..... .. .. . . . . .. .. . .. .. . ...... . .. .0–1...0 0.. ... .... . video..... .3–1.. . ... .... . ... . .. ........ . .. ..1 0... . . . .. .7 0...1 0. .. . .. . . .. . .3 0... . .. ..0–3.. . . ...7–1. . .. .. ...0–2.2 0... . .. . . .. . .. . . . ..4 1. . . ... . . . . . . .... ... .. .6 >5 h 1. .. .. . .. .... .. .. . . ......... . .. ....... .4–4.. ..3–2.... ... . . ... . . . . .. .... . . . .... . . . stress symptoms d: The reference category is indicated by an odds ratio of 1. .. . ..... . . .. .. . . ..0 1... . . .7 1... .. .... .. ..8 1.. .9–1.. ... . .... ....... . ..... .. . . . .. . . ... ... .. ... . . . . . . .. ..7 $42 h 2. . .. . . . . ....... . . . .3 1. .3 .. .. ..5 1...1 0....... . .. ... .. ... .. .. ... ...... ... ... . ...4 1.. .2–3.. . . . .. ... . . .. .. . ...... ... ... .. . school success..3 1. . .... ..4 1.... .. . .2 0... ... .. .. .1 0. .1–3. .. . ... ... .. ..0 0.... .1 0...4–1.... . . ........0–1....... . . . ... . . . ... .. . ... .... . .2 1... .. ... ... ... .. .. . . . . .... .. . . . .. .. ... . . . . . . . ...0 #1 h 1. .....9–1.... .... .7–1. . . . ..... . . ..7–1. ...6 1.... .3 2–3 h 1. ... . .. ....0 0.. . . ... . . .. .8 1.. timing of puberty.. .. ... ... ... . .. .. .3 1.......... . .. . . ....... .... .. . .7 1.. . . . .. . .. . . . . ..5 1.. . . . .. .. .. . . . .. .. . .. ...... .... . .. . ...... .. .8–1. .6 1. . .... ... .. adjusted for age. ... ... ..3 1... ...8–1.. . .. . .... . .. . .to 18-year-old Finns...... ... . ..0 1..... .. .2 1. .. .. . .. . . ..4 0.. .8–1...5–1. . . . .. ... . ... .. . .9 0. .... .......... . .. . . .. .. .1 0. . . . .. . ..... .7–1.. .. .. ..1 2. .9 0..... . .. ....6–1.. .. . . . .3 2. . . . ... ....9–1... . . ... ....... .. . .9–1. .. .. ..... .. . ..... .. .. .8–1... .. .. ... . ... ... . . .. ... . . ..... .. . .... .. ... .4 1. .. . . .. . . . .. . .. .. .. .......0 1–13 h 1. . .. .. . . ... . . . . .... . . ...... . . . .. ... . .. . . ... .2 0.. . . .. .... .... ..... . ...7–1. . .9 0. ....... .2 0. . . .. .7 1.. . .. . ... . ... . ... . . .9 0.... . ........ ....9–1.. .. . . .. .9 0.. .. ...... ..9 1.. . ... .. .. . .. ... .. .. .... . . ...... . . .. . .0 1.... . ..9 0..0–2. .. ... . .0 1...... ..... . . . .. . . ... ... .. .8–3. . . . ... ..... .5 1..0–1.. .. .. . .... .. .. .5 .. ... . .. . .. . . . ... . .. ... . . . ....... . ... .4 . .. . . text messages ... .. ..... . .0 1. . . .. .... . .. .. . . . .. ..8–1.. .7–1. . ... ........ . . .. . ... . .... .. .. ... .... .. ... ..7–3.. . . .. . . . ... ... .. ..... . .7–1. . ..3 1. ........ . . .. . . . 1. . ... . . ....4 $42 h 1. ... .. ....0 .. ..... . ..7 1. .1 1.0 1. . ... ... . . . . ... .. .. . ... . . . . . .... . ....... ..2–2.2 0.1–1. .. . . . .. .. .... . . ..... . . .9 0. . .2 0. . . . ....2 0.. ...... .. . .....3–3.... .. . . ....... . .... . . .. . .4 14–41 h 1.4 ..... . ...... .. . ...... . . stress symptoms d: The reference category is indicated by an odds ratio of 1. . .. .. ... . ... ... . . ..... . . . . .... . . . ..1 0.2 0. . .. . . . .. . . .. . ... .0 14–41 h 1.. ...... . . . . .. . ....6 1. . .. .. .... . . .8 0.. .... .0 1..... .. ... . . . . . . . . ...7–1. .. . ....... ... . .6 >5 h daily 2. ... Not at all or not daily 1... . . .. ....... ......5–2. .. ... . . . ... ..... . ...... .. . .4 1... . .0 1. .... ... . ... . . . .0 0.. . . ... .. .... .. .. . . . ..... ...... ..... . .. . .. .. ..... ...1 0.. .. . . . ... .. . . . . . . . . . .3 1. . . .... ... . . .... . ... .... . .4 14–41 h 1.. .. .4 1..... . ......1 0.0 #1 h 1... .. .. ...3 0.. ... .. . .. . .. ... . . . . . . . .0 1. . . ... ..... ..... .. . . .. . .. . .. . ...0 #1 h daily 1.... .. . .... . .. ...... . . ..... . .9 0. . . .. ..... ... . .2 0.0 #1 h 1.7 0... . . .8–1.... text messages Daily use of mobile phones for phoning... . . ... ...4 1.7 1.... .. . . . . . . ... . .0–2.1 1...... .... . .6 0..... .. .4 0. .7–1... ... .. .. .. .. .. . ... ..... .. . . .....0 0. . ... .. . .. .. . .. ..... . . . ... . .1–1. . . 95% CI) for weekly NSP according to use of ICT among 14.... . . .. .0 Not at all or not daily 1... ..8–1. ... . . ..... . .... 95% CI) for weekly LBP according to use of ICT among 14.. .. . .. . . . . . . . .. ... . .. ..... . ... .. ... ..1 0.0 1.. ... .8–1. . .. . . .... ... .. .. .....3 1... .. . .. . . . .... .9 0.. ..2 1.. . . . .. . ...6 0.. .. . .. . ...0 0.... .2 0. . .0 0... .. . .... .3–5. school success. . ... ..1 0. .. .7 1... . ...... . .7–1.... .9–3. .. . . .. . . .. .... . . .... adjusted for age and sex b: Model 2.... . ... . .. .9–1.... ...6–2.. .. .. . .. Weekly use of the Internet Weekly use of the Internet . . . ......7–1.. .. .... . .. . ... . .. ...8–1. .. . . .. .9 0. . . ..1 0. .... ... . . . . . . ...3 1. ...9–1.... .. . . . ...4 0. . . ......... . ..2–4. .. .... .. .............. ... . .. . . >5 h 1.. .2 1.. . .7–1.... .. .. . .... ....0 0... .0 0. .. . .... . ..7–1. .. . ... .. ..... ..... .. ... .7–1. . .9–2. .. . . .. .... .4 0. . .. .Computer-related activities increase the risk of NSP and LBP Table 2 Risk (OR. . . .. sex..... ..... .... .... . ..... .. or DVD ... .. .. . ..... . ... . .. ... . ... ... . ... . ... . .. .. . ..... .2 0.. .. . .... .9 0. . .. ... . ..... ... . . ... .1 0... .0 $42 h 1. .... . ... .. .9–1. . . .. ... . .. .. .. . ...2 0... . .. .6–1..... . .. ... .5–2.... . .. .9 1.... . .. . ... ... .8 1.. . .. .. .. ..0–3....... . .. ... . ... >5 h 2... ... . .... . . . .. .8 0. .. . playing games...2 . .. . ..8–1... . .. .. .. . .... . ... ... .. .... .... . .. . . . .... . .. ... . . . .. . .. . . . . . . . .8 0. ........9 0.. .... . . . . . .... . .. . ... .. Not at all or not daily 1.. . . . . ..8–1. . .. .. ... Not at all or not daily 1.3–1.... . .. ...8–1. . . . ...5 0. . . .. ... . . .. . ........ .. . .. . .. . . . . 1–13 h 0. .. .. ... . . . ... ... . . .3 Not at all or not daily 1. a: Model 1.3 . .. .... . . .3 4–5 h daily 1. . .. .. .3 1...... . . .1 0.... ..... .. . ...2 2–3 h 1... .. . ... .... ... .3 >5 h 2. ... ..1 2–3 h 0. .. .. . . .. .. . . . ...1 0. . .... . ... . ... ..0 0.. .1 0.7 0..to 18-year-old Finns.. . . . .. ... . ...7 1. .. .. . . . ...1–1. . . .... . .... ..... ........ .2 0. ... ... . . ..... .. . . . . .. .6 1. . . ..... .. ... . .... . . .9 0. ..... . .. ... . . ... . .... . . . . .. . . efficiency of physical activity...... ... . .. .. ..9–1. . . ...5 0. ...... ... ... .. .. .2 0... ... .8–1. . .. . .6–1. . .. ..0 0. . . ... . .. . ... . . . . .5–4.. .... . . ...6 2.... .. . ..7 1. .. . .. ... .. . . . . .. . ..7–1.. . ..5 2..7–1..0 0. . ...... ....... . .... ...... . .. .... . .. .7–1. .. . .. ... . . .. .. . ... . ...... ... . . .... . . . . ..... . .. ..... .. . ..0 1.. ... . .. . ... .. .. . . . . .9 1. . . . . .. . .1 4–5 h 1. . . .. .. . .. ..7–1. . .3 1. Separate models for each ICT variable Exposure to ICT Model 1a Model 2b Model 3c OR OR OR 95% CI 95% CI . parents’ level of education. .. .. .. . 539 Model 1a Model 2b Model 3c OR 95% CI OR 95% CI OR 95% CI Weekly use of computer ........ .. . .... .0 1. .. . ........ ... ... ... ... ... .. . . ... 4–5 h 1.... . . . . .. . . .... ... . . .. . . . . .. ...... . . ... . . .1 0.. .. .... .4 2. ....2–3.3 . . .8 0...2 4–5 h 1.. .. . ... . ..0 Table 3 Risk (OR. . ... .. Not at all 1.. .. . . . .. . ...0 1.. ... .8–1..... . . . .. .. .. .. .. . . .0–1. .. . .7–1. .. .7 4–5 h 2. . ...... .... .... ..0 0.. ..4 1. . .. .. . . . ... . ... .. . .1–3. .6–1.. . .. . .. . . . .. .. . . .... . . ... .. .7–1. .. . ..0 . .. .... . .. .. ..... . .... .. . . .. .... .... . .6 >5 h 2.3 1... . . .. ... ... . . .2 1.. .. . .... ... ..... . ... .. .. ... .. . .. . ........0 1....3 1...6 0.... .. ........ . . . .. . . .. ... .5–2.. ... .. .1 0.. . . .. .. . . . . . .... ..... . . . . video. .. . .. .. .. . . . . . .. . d 1. ...... . .2 . ...2 0. . . ... . ...1–1. . .. 1. Not at all 1........8 0.. ... .. .0 0. .. .. .9–2.... .. .. ... .... . . ... . . . ... ... . . .. . .. .. .9–2.. ... . .9 1. .. . ..... ........ .. . ... .... . .. ... ..... .. ....0 #1 h 1. ...0 . parents’ level of education.. .1 .. ...0 0. . . . . . .. . . .6 >5 h 1.. ... . .. .0 1–13 h 1. .... . .... .. . ... ....... ... . .0 1–13 h 0. . . ... ....7 1. . . ...... .. ... .... .. .. .... . . ......9–1.4–4. ..... .8 1... . . ... ..0–3.. . .2 0. .. . .. . . . ... . . . .... .. .... . . .9 0. . . .. .. .. ... .. .0 0. . . .. .. . . . .. .. ... . ... .... .. ..... . . . ....0 0. . . .. .. .0–1.0–1...... ... . . ..... ..... . ... .. ..0–3. ...3 14–41 h 1. . . . .... . . .... .9–1.. . ... . .. .. ..7–1.. timing of puberty.. .. . .. .0 0.. . .... ...... .. .. . . ..2 0.... . . ... ... .. . .. .. . . .. ..9–1.. . . . .. ... .. ... ... . . ... . . . . ..0d 1. . . . .... .... . . . . . ... .. . .. . . . ..8–1.. . ........... .9 0... . ..... . . .. .. ..... .. ... .. . #1 h 1. .. ... ... ... .. . Not at all 1. .. .... . .. .... .. .... . . ... .. . .... ... . . . .... . .... . ..9 0. .1–3.. .... . . .. .. .... ..... .. . .. .8 1.. ... . . .0 1... . ...0 0....3 1.3 1.... .. . .. . . .. .... .. . . ... .... ..............4 ..... . . ..2 1.. . . .... ......0 0. ... . .. . . .. . . . . . ... . . .. . .6–1..5 1... ....... ... ..9 0.... . .... . ... .. . . . ..7 1... .... .. .. . ........ ...... ..... .. .. . . . . . . .. . . ...4 >5 h 2..3 4–5 h 1. . . .. ... ..... . ... ..1 0. . timing of puberty.. . ...... . .. . . ... . . .. . . . . ... .. .1–3... . ... .... .. ...6 1...7 1. . . .. . .. . . ... . ... .. .... . . . . . .. . . . . . . .. . .. ..3 1. .... . . . .. .. .. . 4–5 h 0. ... .0 1.... . . ... . .. .. . .. .. . . . . . . . . . ..... . ...4 1. ..2 1.. .4 1. .. . ..... . . . . .. .... ....3–3. . . .... .7–1... . .... . . . . .... . ..... ... . .. .6–1. . .... .1 0. .. ... . ... timing of puberty c: Model 3. .7–1..8–1...... .1 1. . . . .7–1... . . . Not at all or not daily 1. .. . ... ..... . ..... . . .. .. . ... ..0 0. . . .4 0. .. . . ... ..0 Not at all or not daily 1. .... . .. .... .... .. . . . . ...2 1.. . . school success. .. ..... . . . . adjusted for age and sex b: Model 2... . ....0 0...7 0... . ...

as in computers..1 and this is confirmed by our findings when exposure times in digital gaming and computer use were high. P.25 Computer work means sitting at desk with the neck in flexion position. An increasing proportion of work force will perform their work career in information and communication work. while the keyboard and mouse operation requires repetitive upper extremity motions.  With ICT-involving leisure activities adolescents are confronted with a new health risk. Our results bring new information suggesting that computer use exceeding 2 h/day is a threshold for NSP. The response rate of the survey was fairly good. Insufficient recovery after local muscle fatigue is believed to be essential in the genesis of muscular pain in static work. Kemila¨ J. Widespread pain and neck pain in schoolchildren.J. Kautiainen H. Neck and shoulder symptoms and leisure time activities in high school students. Acknowledgements Contributors: A. J Orthop Phys Ther 1996. nor were mobile phones use and viewing television associated with LBP after adjusting for confounding factors. or more. et al. Salminen JJ. 5 Vikat A. that with these modern leisure activities adolescents are confronted with a new health risk.1. Eur Spine J 1999.R. although the rates were lower in boys and older age groups than in girls and younger age groups.H. NSP and LBP are known to be multifactorial and the different factors may interact.R. NSP and LBP are signs of physical and mental loading. Key points  Neck–shoulder pain (NSP) and low back pain (LBP) increased among adolescents in the 1990s simultaneously with the increase in use of information and communication technology (ICT). The devices remaining immobile on the desk. References 1 Balague´ F. Prevalence and 1-year persistence. It is possible. LBP is known to be related to prolonged sitting position.H. We express our gratitude to Mr Lasse Pere for data management and to Mrs Marja Vajaranta for revising the language. pain at computer work was more easily felt in the neck and shoulder areas than in the lower back. Sourander A. Levoska S. and J. L. Salminen J. stress or psychological strain might activate the central nervous system to varying degrees resulting in activation of muscle spindles. Pain 1997. provided critical input in all phases of the study.28:164–73. the City of Helsinki Health Centre. Neck or shoulder pain and low back pain in Finnish adolescents. and J. The present study is the first illustration of the lack of an association between using mobile phones and reporting NSP. However.24:25–9.26 Associations between NSP and LBP and computer use were observed in our study. et al. Salminen JJ. and console games is a multiform activity of different postures. Case definition was based on the frequency of pain. Long-term studies and ergonomic interventions are needed to prevent health risks involved in computer-related activities. using computers every day. the Medical Research Fund of the Tampere University Hospital.  We study how the use of ICT is related to NSP and LBP in adolescents. As an occupation apparently not exerting a load on the upper extremities television viewing was not associated with NSP. and A. the worker is obliged to maintain the same static posture while working. Competing interests: None declared. On the other hand. NSP in this case may be a stress symptom rather than an independent risk factor.27 Increased muscle tone can lead to painful tensional syndromes. Subjects with stress may have a lowered threshold of reporting pain symptoms. 3 Mikkelsson M. Non-specific musculoskeletal pain in preadolescents. we can expect increasing sick leaves and early retirements.R. Playing video games has previously been reported to be a risk factor for LBP among 9-year-olds. performed the main analysis. There are limitations associated with the reliability and validity of postal surveys. et al. P. In conclusion. Test–retest reliability in regard to the exposure time of symptoms and ICT variables was good. initiated and designed the study. and digital gaming exceeding 5 h/day is a threshold for LBP. sending text messages. drafted the paper and coordinated subsequent revisions with the other authors. but pain intensity and disability caused by symptoms might have provided a more thorough picture. lying. A. Scand J Public Health 2000. Salminen J. Some previous studies have shown a correlation between time spent on viewing television and back pain. This study was funded by the Ministry of Social Affairs and Health. the basic mechanism of gaming relies on dynamic action where players change postures freely and the loading of the upper extremities is minimized. The study was based on a large representative sample.S. Although mostly requiring repetitive hand motion in sitting position.540 European Journal of Public Health Discussion According to this study computer-related activities are positively associated with NSP and LBP among adolescents.10 Digital game playing as in computers. and exceeding 5 h/day for LBP.23 while others did not.T..T. even obvious. . television. We discovered digital gaming to be related to LBP but not to NSP.S. Supposing that these symptoms now emerge 20 years earlier in a lifespan than in previous generations. 2 Mikkelsson M. or sitting. Times spent on digital gaming and using mobile phones were not associated with NSP. Musculoskeletal symptoms are common among the middle-aged and people in work life in general. and their relationships to NSP and LBP produced parallel results. and the Information Society Institute of the University of Tampere. An indirect analysis of non-respondents showed that there were no systematic or statistically significant differences in the symptom categories or in the ICT variables between respondents and non-respondents.J. information is displayed on a screen and processed via manual input devices like keyboard and mouse. True daily variation in ICT use and occurrence of symptoms lowers the test–retest reliability.88:1119–24. and phoning while walking.28 a mechanism that might explain the association between spinal pain and computer-related activities as well. On the other hand. Rimpela¨ M. 4 Niemi S. our results suggest that increased computerrelated activities are an independent risk factor for NSP and LBP in adolescence. the Internet. association with NSP disappeared after controlling stress symptoms. In visual display unit work.  Risk of NSP increased when computer use was 2–3 h/day. are the guarantors for the paper. This is the first comprehensive attempt to establish a connection between exposure time to computer-related activities and NSP and LBP among adolescents. Viewing television was associated with LBP when viewing time exceeded 5 h/day.S.73:29–35. Adolescents are playing games.8:429–38. A prospective one-year follow-up study. Non-specific low back pain in children and adolescents: risk factors.  Risk of LBP increased when computer use and playing digital games exceeded 5 h/day.19. only to disappear after controlling for stress symptoms. which may overload the upper extremities rather than the low back. a fact that emerged also in multivariate analysis. standing. Three different questions measured the daily and weekly computer use. Acta Paediatr 1999. Troussier B. the Health Promotion Research Program of the Academy of Finland.

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